----Original Message Follows----
From: Robbie Coull <[log in to unmask]>
...I'm working in a GP-run ER in far-north Saskatchewan for a few months and
the level of irradiation going on is incredible (although in their defence
they do have a TB problem).
---> Well, you'd think this high level of irradiation might be necessary
just to keep warm in the "far North"...
Just kidding. Have been down in Bermuda for a while now and here too one has
the rather frequent encounter with unexpected lateral chest views and even
rib views. The police here, though, do not have a say, but patients, to a
far greater extent than in the UK, request/expect X-rays.
So we fight a bit...
And I do get irritated when someone from North America points out to me how
few the lawsuits are about people X-rayed unnecessarily, while the opposite
situation...
But I have resorted, say when doing a CXR to R/O a pneumothorax in someone
who has clinical rib fractures, to changing the way I request them. The
problem is when the radiographer sees the words "# rib", they sometimes
think that a better look at those is the reason for the X-ray request. So I
tried writing down on the "View requested", not only "CXR", but "CXR to R/O
pneumo". Worked for a while and then I got a rib view again (although less
frequently). Now I write this AND then, in capitals, "NO RIB VIEW PLEASE".
Has not failed yet.
We get into a debate here quite often about whether there is a need for a
CXR to R/O pneumo in someone with a simple minor trauma, resulting in a
clinical picture of about 1 rib # with otherwise no symptoms (but pain), no
flail, A/E normal, Sats good, no other risk factors and claiming that he/she
are not intending to fly/dive soon. We get into debates about how long to
avoid flying after a #rib+pneumo is diagnosed and whether you must wait for
100% radiological resorption and, if so, whether you should then wait any
particular amount of time further. This was recently discussed on the list
in some aspects, but it's a big debate here still.
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